Provider Demographics
NPI:1215996848
Name:CECCARELLI, LEONCIO A (MD)
Entity type:Individual
Prefix:DR
First Name:LEONCIO
Middle Name:A
Last Name:CECCARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HOSPITAL DRIVE
Mailing Address - Street 2:STE 209
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-766-5656
Mailing Address - Fax:710-766-6919
Practice Address - Street 1:325 HOSPITAL DRIVE
Practice Address - Street 2:STE 209
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-766-5656
Practice Address - Fax:710-766-6919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016958207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH5940486Medicare ID - Type Unspecified
B69942Medicare UPIN